Examining the relationship of immunotherapy and wound complications following flap reconstruction in patients with head and neck cancer

Abstract

Background Immunotherapy agents are used to treat advanced head and neck lesions. We aim to elucidate relationship between immunotherapy and surgical wound complications. Methods Retrospective multi‐institutional case series evaluating patients undergoing ablative and flap reconstructive surgery and immunotherapy treatment. Main outcome: wound complications. Results Eight‐two (62%) patients received preoperative therapy, 89 (67%) postoperative, and 33 (25%) in both settings. Forty‐one (31%) patients had recipient site complications, 12 (9%) had donor site. Nineteen (14%) had major recipient site complications, 22 (17%) had minor. There was no statistically significant difference in complications based on patient or tumor‐specific variables. Preoperative therapy alone demonstrated increased major complications (odds ratio [OR] 3.7, p = 0.04), and trend to more donor site complications (OR 7.4, p = 0.06), however treatment in both preoperative and postoperative therapy was not. Conclusions Preoperative immunotherapy may be associated with increased wound complications. Controlled studies are necessary to delineate this association and potential risks of therapy.

Preoperative Immunotherapy in the Multidisciplinary Management of Oral Cavity Cancer

“…aimed to elucidate the relationship between immunotherapy and surgical wound complications in patients undergoing ablative and flap reconstructive surgery. The results indicate an association between preoperative immunotherapy and major complications requiring invasive surgical treatment (OR 3.7; p = 0.048) and any type of treatment for complications in patients receiving preoperative immunotherapy (OR 2.9; p = 0.008) ( 77 ). Although there are inherent limitations in a retrospective case series with no true matched case-controls, the study findings highlight a need to assess the timing of immunotherapy in the preoperative period so as to limit potential surgical morbidity due to prior treatment.…”

Safety and short-term outcomes of gastrectomy after preoperative chemotherapy plus immunotherapy versus preoperative chemotherapy: a retrospective cohort study

“…Some case reports have suggested that preoperative immunotherapy followed by gastrectomy for the treatment of AGC patients is effective and safe [18][19][20]. Previous studies have shown that preoperative immunotherapy might be associated with increased wound complications in head and neck cancer [21,22]. However, one study indicated that esophagectomy was not associated with an increased risk of perioperative morbidity or mortality in patients with locally advanced esophageal cancer treated with neoadjuvant chemoradiation plus immunotherapy [23].…”

Association of Neoadjuvant Pembrolizumab for Oral Cavity Squamous Cell Carcinoma With Adverse Events After Surgery in Treatment-Naive Patients

“…The potential neoadjuvant role of PD-1 inhibitors in primary surgical management of HNSCC and its effects on surgical outcomes are incompletely understood at present. Previously, a large multi-institutional retrospective study reported an increase in surgical complications with the use of preoperative immunotherapy in HNSCC, suggesting poor wound healing resulting from those receiving treatment …”